Director, Pharmacy Health Plan

1 day ago Be among the first 25 applicants Get AI-powered advice on this job and more exclusive features. G.E.H.A (Government Employees Health Association, Inc.) is a nonprofit member association that provides medical and dental benefits to more than two million federal employees and retirees, military retirees and their families. We celebrate diversity and are committed to creating an inclusive environment for all employees. G.E.H.A has one mission: To empower federal workers to be healthy and well. Offering one of the largest medical and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care. We serve our members with products they value and a personalized customer experience, sustained by a nimble and efficient organization. The Director of Pharmacy Health Plan will guide and improve our Federal Employee Health Benefit (FEHB) and Postal Services Health Benefits (PSHB) environment as market, member, and regulatory needs change. We are looking for a strategic Health Plan Pharmacy leader to manage delegated PBM contract oversight (inclusive of utilization and formulary management), oversee clinical initiatives and programs (Medication Therapy Management, HEDIS/Quality) and monitor disputed claims processes. This leader will also partner closely with the VP of Pharmacy and other enterprise leadership to drive business outcomes and meet regulatory, affordability, clinical quality, and corporate goals. In this role, your leadership will: Evolve our pharmacy management model by partnering with stakeholders and vendors to better outline the total cost of care capabilities. Collaborate with internal and external partners to achieve business goals aligned with short-term and long-term strategies. Empower others to support G.E.H.A in improving member experience and growth. SKILLS In this role, you will do: Pharmacy Strategy & Operations Oversight Set strategic direction for program development, achieving appropriate outcomes and business performance measures related to access, affordability, quality, and experience, including business performance, clinical pharmacy operations, PBM and vendor oversight, utilization management, and formulary. Ensure operational excellence of the pharmacy benefit program at G.E.H.A. Partner with internal stakeholders regarding clinical programming, product development, benefit design, and vendor negotiations. Manage department staff (clinical and non-clinical) performance, development, and succession planning. Foster departmental development and ensure high performance to support the organization’s mission and strategic goals. Lead cross-functional initiatives with internal and external partners to improve pharmacy program efficiency and innovation. PBM Contract Oversight & Performance Management Day to day management of the commercial PBM and Medicare Part D / EGWP administrator relationships for the FEHB and PSHB lines of business. Analyze and track PBM performance against key performance indicators, ensuring alignment with corporate goals. Oversee changes in pharmacy benefits implemented by the PBM, ensuring compliance and strategic alignment. Regulatory Compliance & Accreditation The role ensures compliance with all relevant contracts, accreditation criteria, and federal regulations, including those from OPM for Federal Employee Health Benefits (FEHB) and Postal Services Health Benefits (PSHB) along with those for CMS for Medicare Part D / Employer Group Waiver Plan (EGWP) through our administrator. Monitor and interpret the CMS and OPM landscape, implement OPM Carrier Letters, develop policies and procedures to maintain compliance, and partner with the GEHA Compliance teams to provide documentation and notification of compliance initiatives. Financial & Clinical Program Leadership Lead the development and execution of financial strategies for drug pricing, discounts, rebates, and reimbursement to optimize plan cost savings. Oversee department budgetary aspects of the pharmacy department, ensuring fiscal accountability and cost-effectiveness. Collaborate with teams across the clinical division to implement clinical programs that enhance quality, patient safety, and medication adherence. Requirements Licensed pharmacist (PharmD) required. 10+ years of experience in managed care pharmacy, pharmacy benefit management, or the PBM industry. 5-7+ years of experience managing PBM relationships and contracts. 5+ years in leadership roles with a focus on operational and strategic oversight. Expertise in formulary management, utilization management, and regulatory compliance in both commercial and government programs. Preferred Qualifications An advanced degree (e.g., Master’s in Healthcare Administration or Business Administration) is preferred. Knowledge of FEHB federal benefits and Medicare Part D / EGWP regulations. Strong problem-solving and decision-making skills. Proficiency in data analysis, financial modeling, and performance metrics. Ability to manage multiple initiatives and meet deadlines in a demanding environment. Excellent verbal, written, and collaboration skills. Experience with accreditation standards and regulatory compliance frameworks. Demonstrated ability to lead cross-functional teams and drive organizational change. Work-at-home requirements Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office. A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required. Latency (ping) response time lower than 80 ms Hotspots, satellite and wireless internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information How we value you Competitive pay/salary ranges Incentive plan Health/Vision/Dental benefits effective day one 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution Robust employee well-being program Paid Time Off Personal Community Enrichment Time Company-provided Basic Life and AD&DD Company-provided Short-Term & Long-Term Disability Tuition Assistance Program While this is a remote opportunity, at this time G.E.H.A does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, Maine. Please note that the salary information is a general guideline only. G.E.H.A considers factors such as (but not limited to) scope and responsibilities of the position, candidate’s work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer. The hiring range for this position is $169,320 - $214,200 USD. At G.E.H.A, the current maximum salary for this role is $238,680 USD. While initial compensation may vary based on experience and qualifications, there is a path to work toward this top rate through performance and continued growth within the organization. G.E.H.A is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. G.E.H.A will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees. Our diversity drives innovation deepens connections and strengthens our organization. G.E.H.A is headquartered in Lee’s Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles. Seniority level Director Employment type Full-time Job function Health Care Provider and Management Referrals increase your chances of interviewing at GEHA Health by 2x Inferred from the description for this job We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr